Five-year survival has doubled since mid-1990s

Action Points

Median and 5-year survival rates among U. S. women with metastatic breast cancer (MBC) have improved, especially among younger women, according to data from the National Cancer Institute.

Realize that the data indicate MBC is not the immediate death sentence it once was, and women with MBC can and often do live for years with reasonable quality of life, albeit undergoing constant treatment to keep their disease under control.

An increasing number of women in the U.S. survive with metastatic breast cancer (MBC) as both median and 5-year survival rates improved, especially among younger women, according to a back-calculation method study.

As of Jan. 1, 2017, 154,794 women were estimated to be living with MBC in the country, 75% of whom had initial diagnoses of stage I to III breast cancer and later progressed to MBC, reported Angela Mariotto, PhD, of the NCI in Bethesda, Md., and colleagues.

"At one time, a diagnosis of distant recurrence or de novo stage IV meant that death from breast cancer was likely to be imminent," the authors stated. "Today, with the development of new therapies that target the drivers of breast cancer and with improved palliative care, MBC is not the immediate death sentence it once was. With optimal care, women with MBC can and often do live for years with reasonable quality of life, albeit undergoing constant treatment to keep their disease under control."

The researchers relied on the Surveillance, Epidemiology and End Results (SEER) registries to calculate the prevalence of women who were initially diagnosed with de novo MBC, as well as those who progressed to MBC after being diagnosed with earlier-stage disease. The method they used to calculate the prevalence of MBC was based on a model that assumed that each documented death from breast cancer was the result of either de novo MBC or a recurrence leading to MBC.

Based on their calculations, they found that the number of women in the U.S. living with MBC increased by 4% between 1990 and 2000.

From 2000 to 2010, the number of women in the U.S. living with MBC increased by 17%, and this rate is expected to increase by 31% between 2010 and 2020. Also, 40% of women with metastatic disease lived for 2 years or less but slightly over one-third at 34% lived for 5 or more years with advanced disease.

A model of survival estimates involving 25,935 women with de novo MBC showed that median survival increased from 22.3 months in the years 1992-1994 to 38.7 months in the years 2005-2012 for women ages 15-49. For women between ages 50-64, median survival increased from 19.1 months in 1992-1994 to 29.7 months in 2005-2012.

Moreover, over 11% of women under age 64 diagnosed with de novo MBC between 2000 and 2004 survived 10 years or more, survival rates being higher for younger women.

The study's main limitation was that the data set does not contain any estimate of population-based survival rates following recurrence of MBC.

"To our knowledge, this is the first time that the number of women living with MBC in the United States has been estimated," Mariotto's group concluded. "These estimates provide a new perspective on the population burden of breast cancer and have great potential significance to the research and advocacy community working on behalf of patients with MBC and their families."

Charles Shapiro, MD, of the Tisch Cancer Institute at Mount Sinai in New York City, told MedPage Today that women with MBC are now in some sense "survivors" just as women diagnosed with early-stage disease often are, most of whom will be cured of their cancer.

"I think the point is that not only are we going to have to pay attention to long-term survivors with early-stage disease, but we also have to pay attention to people who are living with metastatic breast cancer as a chronic disease, and there are issues related to this disease state as well, although they're different than those with early-stage disease," Shapiro said. "So we are happy this is occurring; we have had great improvements in our drugs and it's reflected in the longer survival times and that's good news."

Shapiro, who was not involved in the study, added that "it behooves us to recognize that metastatic breast cancer is not an immediate death sentence anymore, the median survival is longer today than ever before, and we have to start considering physical, psychological, and sexual issues in metastatic breast cancer patients."

Mariotto and co-authors disclosed no relevant relationships with industry.

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